All Jun_2023 https://t.me/silent_2023m _________________________________________________________________________________دعواتكم Patient with anemia symptoms. Labs: MCV: 68 RBCs: 5 RDW: 20% Other labs are not valuable. (No iron study) What is the most likely diagnosis? A- B12 deficiency B- Thalassemia C- Iron deficiency anemia 28 weak still birth with congenital anamoly , how will you know the Causes? A-Placental saming B- Cord sampling C-Fetus sampling 30 years old male gymnastic well body builder complaining of scrotal hernia asymptomatic but the patient has concerns about it , what to do? A-herniotomy B-herniorrhaphy C-Observe Young female presented with heavy vaginal bleeding has been diagnosed with uterine fibroid. Her hemoglobin is 7. What is the most appropriate next step? A- Myomectomy B- Correct the anemia C- Combined Oral Contraceptive Pills Pregnant female has PPROM at 31 weeks of gestation and got conservative treatment, now she comes at 35 weeks of gestation with labor. What is the most common neonatal complication for her condition? A- Neonatal sepsis B- Skeletal deformity C- respiratory distress syndrome Lung nodule 7mm no symptoms no risk factors A. CT in 6 months B. biopsy C. surgery D. reassure 1 of 51 Nurse tell you about patient in ICU (in the case she talk about his history and recent change and tell to come see him) what is this part of communication: A. Situation B. Background C. Assessment A patient wants to give a doctor a gift? A. Refuse B. Accept C. Accept and report to department 20 y.o healthy male. Acute left-sided chest pain. Stable. ECG normal. CXR is shown. Most appropriate treatment? A. lncentive spirometer B. Barium swallow study C. Thoracotomy D. Chest Tube Company want to study subgroup of people for prevalence of Alzheimer's disease , what method used by the IRB to check the ethical point A. Utilitarianism B. Skeptic ethics C.Delogatory A child says his name, feeds himself, separates easily from his parents (was written like this), and ride tricycle: A. 2 B.3 yr C.4 D.5 ▪ Separates easily > 3yrs ▪ Know full name, age and gender> 3yrs ▪ Tricycle> 3yrs Ptn underwent laparoscopic cholecystectomy then after pneumoperitoneum develop HR 40/min What is the cause.. A- increase after load B- rapidly dilatation of peritoneum 35 years old patient come with medial leg ulcer. The most likely diagnosis is: A- Diabetic B- Venous hypertension C- Atherosclerosis D- Buerger's disease Pregnant in labour and take drug that decrease resp.distress syndrome.. A-aspirin B-oxytocin C-glucocorticoid 2 of 51 Pregnant with high tsh and constipation, cold intolerance what yo give... A-propylthiouracel B-thyroxin Female with pco and hirsutism ..made a lot of cosmotics but no result..what to give. A- metformin B-finasteride C-coc Ref / amboss Mother of diabetic child attends educational classes about hyperglycaemia and hypoglycaemia what is the benefit.. A- increase self efficacy B-increase dependent in daily activities 3 years old asthmatic child, mother is concerned as they are not leaving the house much as they must use the nebulizer and it needs power source, what to advice? A. The mother is right B. Find a portable nebulizer C. Educate about inhaler use and stop nebulizer EARTH Prevention type in patient diagnosed with stroke , now he is on physiotherapy and disease prevention ? A : tertiary B: secondary C: primary D : rehabilitation without prevention TYPE OF HEIGHT DELAY cause ? A : hormonal B : constitutional Child with bone age greater than chronological age, what is the diagnosis? A- Congenital Adrenal hyperplasia B- Chronic renal disease C- Hypothyroidism D- Familial short stature ▫ If BA< CA = constitutional delay ▫ If BA> CA = pathological delay ▫ If BA=CA = Familial short stature ▫ BA=Bone age ▫ CA=Chronological age (actual age) Mother brought her 9yrs child for short stature Physical exam was normal GH normal FSH normal TSH NORMAL T3-4normal 3 of 51 Insulin like growth factor decreased X ray: bone age of 6yrs Dx? A-Familial short stature B-GH deficincy C-Constitutional growth delay what will be changed during pregnancy? A : increased tidal volume Pregnant with asthma what happens during pregnancy? A.increase RR B. Increase tidal volume C. Increase resdual volume D. Increase functional resdual capacity UpToDate: - RR remains unchanged - Tidal volume is increased up to 40% - Residual volume is decreased - Functional residual capacity is decreased Findings in a research report show that the incidence of a particular disease in Saudi Arabia is higher in females than in males but the prevalence is equal in both females and males. How can this be explained? A) Fatality cases are higher in females B) Fatality cases are higher in males C) Females carry the disease for longer D) Males carry the disease for longer Pediatrics pt ( i forget age) admitted to PICU with subdural hematoma ( I think but im sure it's a Brain bleed) , The father said he fell from his bed ( this all the hx ) on PE the pt. Had 4 of 51 ecchymosis on the buttocks and Back and he have bilateral femoral fracture , what’s the diagnosis? A) Hematoma B) Pathological Fracture C) Battered child syndrome REF : AMBOSS The doctors want to do Tube ligation ? A: Take consent from her or her representative B: Take concent from husband C: Take consent from her and tell her to tell the husband WHO surgical checklist safety ? A: before admission, before skin incision, at discharge B: before induction of anesthesia, before skin incision, before pt leave OR C: before admission, before induction of anesthesia, before pt leave OR D: before admission, before induction of anesthesia, at discharge REF : WHO MUSSLE AFFECTED IN ENURESIS ? ANS : Detursos 4 months milestone ? nurse called the doctor about a patient for an urgent medical prescription, he prescribed it , what’s the next thing to do .? A : ask another nurse to approve it RECALL: Patient with ectopic pregnancy presented with andominal pain , the nurse called the doctor he was busy and asked her to give medication to the patient 1- ask another nurse to approve 2- give methotrexate 3- give paracetamol 4- Doctor cant prescribe over phone Fluid maintenance for daily (weight 10kg) A : 1000 1. For the first 10 kg: 100 mL/kg (10 kg x 100 mL/kg = 1000 mL) 2. For the additional weight up to 20 kg, add 50 mL/kg. However, in this case, the individual weighs only 10 kg. No need to add fluid for this range. 3. For weight above 20 kg, add 20 mL/kg. The individual weighs 10 kg, so there's no need to add any fluid for this range either. If there is a deficit u should calculate the deficit and add to Maintenance Deficit = wyt loss 10 5 of 51 Burn What type of bacteria is causing the green discoloration? Ans : Pseudomonas aeruginosa Pregnant with high random blood sugar reading and fasting sugar. She’s at risk of what vaginal Infection? co A. Candida B. Bacterial vaginosis Female pt with vaginal candida, which following disease she has? A-DM B- HTN C- Epilepsy 38 GA have chlamydia infection during deliver baby … what most common acquired concerning infection to new born ? 1-Eye 2-Liver 3-Ear 4-Lung A physician was working on reasearch paper , before publishing it ,he made some changes to some of the data and omitted other parts of his results. What is this action referred to? A) Falsification B) Fabrication C) Plagiarism D) Near miss An elderly with end stage cancer c/o severe pain. The family asked the physician to give a stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate the pain, it also might hasten their father’s death. Which of the following is this referred to? A) Principle of subsidiarity B) Principle of double effects C) Principle of totality D) Principle of informed choice Patient couldn’t go through spontaneous vaginal delivery, and the fetus is in distress, doctor want to do cesarean section but the patient refused and wanted second opinion? A : father opinion have priority B: try to persuade her against her well!!!!! C : wait for second opinion Obstetricians should work emphatically to encourage a pregnant woman to accept a cesarean birth if the risk of morbidity or mortality to the fetus is high.Without a doubt, court order should be sought as a last resort. Indication to screen for gestational diabetes in early time at pregnancy ( 18 w gestation) ? 6 of 51 A:Husband Hx of diabetes B: previous gestetional diabetes C : previous baby with cleft lip a researcher doing a study about incidence, prevalence and burden of diabetes mellitus after insulin brought to the world as a therapy in 1960 which of the following is mostly found: A.incidence decreased B.prevalence increased C.increased mortality An 18-month child was brought to clinic for a regular checkup. The doctor found out that the child had not taken any of his scheduled vaccines. He asked the mother why and she replied “Vaccines will make my son retarded!”. What is the appropriate action? A) Refer the mother for psychiatric assessment B) Contact child protection services C) Explain the benefits of vaccines to the mother D) Contact the hospital ethics committee Exzema distribution in 8 years old? Flexors czema site; • less than 6M; scalp-face, • 6M to 2-5 Y;extensors, • 2 to 16 years; flexors, • psoriasis site ; scalp (Facial eczema not responded to low steroids; tacrolimus cream) SLE most specific test? case scenario about the pregnant lady with swelling in the left leg of the following is the best management? A. Duplex and heparin B. Duplex and heparin and IVC filter C. Warfarin Thin , tall , high arched palate, curved back , what's the syndrome ? A : marfan 7 of 51 B: klinefelter question about in Saudi they want to reduce the prevalence of dengue fever, which region should be targeted first : A. central B. north C. west D. east NIH: vailable information suggests that dengue fever is endemic in certain cities of Saudi Arabia, such as Jeddah and Makkah, which are located in the western region researchers study on 2 grounds of NSAID .. participatiant was in online interview the ethics errors here ... A. gathering information is not accure B. privacy not valid C. infomed consent will not be monitored Mono mono twins. When did separation happen? A) 0-72 hours B) 3-7 days C) 8-12 days D) > 12 days • D-D=0-3 days • D-M=3-8 days • M-M=8-13 days severe dysmono with infertility for 6yrs : A. endometriosis B. adenomyosis Patient on chemotherapy need relief of pain the neurs call the doctor to give him : A. tell another nurse to approve B. refuse C. tell written consent Child can skip , draw rectangle, count to 10 , age in years A.2 B.3 C.4 D.5 5y; Tie his shoes, skipping, draw triangle Baby 9 month I guess missed 6m and 9m vaccines due to traveling .. A.Catch up vaccines B. give all vaccines CDC: The CDC provides a catch-up immunization schedule for children based on age whose vaccinations have been delayed 8 of 51 A summary of recommendations for child/teen immunization indicates that for children lacking previous Tdap, Tdap should be given routinely at age 11-12 years and older teens should be vaccinated on a catch-up basis. Pt with paracetamol ingestion, doctor send the result and ask the nurse to write it done once it is resulted, the lab tech calls the nurse and say 1 then pause then 25 So the nurse write it down 1.25 Instead of 125, as a result the pt develop irreversible liver failure What is the error or who is wrong ? 1- dr didn’t check the lab once resulted 2- miscommunication between nurse and lab tech 3- the nurse didn’t write correctly 4- can’t remember US picture of twins and say it's monochorionic diamniotic ,cleavage at which day ? A) 0-72 hours B) 3-7 days C) 8-12 days D) > 12 days The question of the child with widening of the joints, I remember the question with numbers exactly: Ca 2.2 (Normal 2.2 - 2.7) Phosphate 2.1 (Normal 1.3- 2.3) ALP >1000 very high It was exactly like this, no PTH given What is the most likely diagnosis? A- Hypophosphatasia B- Renal osteodystrophy C- Vit D deficiency rickets D- Familial hypophosphatemic rickets 9 of 51 Female came with yellow vaginal discharge and fishy smell as well, she also have itching, what is the cause of her presentation: A- Candida infection (white, cottage cheese-like discharge) B- Bacterial vaginosis C- Chlamydia infection ( sexually transmitted infection that can cause a thick, yellow discharge without a smel) D- Trichomonas infection ( yellow or green discharge with an unpleasant, fishy smell) screening for asymptomatic bacteriuria in pregnancy: a) 12 weeks b) 20 weeks c) 27 weeks d) 31 or 32 weeks Patient with HTN not responding for three anti hypertensive drugs on Ultrasound the one kidney is bigger what is diagnosis A Adrenal hyperplasia B Renal artery stenosis 10 of 51 C Pheochromocytoma 15years old case of meningitis LP to be done what to do A. Take consent form parents and assent from patient B. take consent from parents and donʼt assent patient C. no need for consent D. consent patient only Hepatitis B vaccine? A. Live attenuated B. Recombinant C. Toxoid D. Killed CDC : The Hepatitis B vaccine is a recombinant vaccine Patient has MI 6 weeks ago now he presented with dyspnea cough and frothy sputum with harsh systolic murmur heard over the pericardium what is the diagnosis? A- PE B- Tricuspid regurgitation C- papillary muscle rupture D- can’t remember 58 years old male patient had Myocardial Infarction 6 weeks ago , presented to the ER with dyspnea cough and frothy sputum with harsh systolic murmur heard over the precordium what is the diagnosis? A- PE B- Tricuspid regurgitation C- papillary muscle rupture D- ASD yo female medically free. Her father had colon cancer at age 53. Her mother had breast cancer at age 43. What's the appropriate screening for her: A- Mammogram annually B- Mammogram at age 40 C- colonscopy at age 50 D- Mammogram at 40 and colonscopy at 50 35 year old femal her dad has colon cancer when he was 55 and her mom had breast cancer when she was 43 asking about screening: A she should do mammogram annually B start mammogram at 40 11 of 51 C start mammogram at 40 and colonoscopy at 55 D colonoscopy Pediatric present with macular rash adenopathy ,hepatomegaly,symmetrical and asymmetrical small and large joint arthritis with ESR and CRP high DX? A- psoriatic arthitis B-systemic juvenile idiopathic arthrits C-juvenile poly arthritis D-puaci juvenile idiopathic arthritis a patient will undergo weight reduction surgery, how to decide which type of surgery to do? A- endoscopy B- CT abdomen C- barium study D- abdominal ultrasound Male patient had oil dissolvent injury to his index finger. On P/E mild tenderness when moving the hands and no other abnormalities, what is your next step? A) Oral antibiotic B) Oral antibiotics and steroid C) Elevate the hand and ice packing D) Surgical management A mechanic had an accidental injection of oil dissolving in his index finger Finger is red and swollen with mild tenderness and normal joint movement, sensation is intact what to give: 1. Oral antibiotic 2. Oral Abx and steroids 3. Surgical management 4. Elevate the hand and ice packing A patient has had an oil dissolvant injected by a mistake in his fingers what is the appropriate management? 1. Surgical removal of the dissolvent 2. Put ice and left it 3. Antibiotic 4. Steroids 65 with DM and HTN admitted for elective ventral hernia repair, on examination he has bilateral Basal crackles and lower limb edema, what is most appropriate? A-Open repair now B-Laparoscopic repair now C-Optimization then surgery D-No surgery unless there's obstruction 65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination bilateral crepitation, ascites and bilateral edema, what to do? A- Proceed with hernia repair. B- Don’t repair unless obstruction has occurred C- Delay until situation is controlled. 24 yo male presented with bulging that appears with cough and lifting heavy objects, on examination it was inguinosacral and reducible. What is the dx? A-Direct inguinal B-Indirect inguinal C-Femoral 12 of 51 D-Lonar or lacunar Pregnant case of epilepsy for 2 years and poor control despite medication , what will you do? - review the medication Women with uncontrolled epilepsy for a while came for preconception visit, which of the following is the most important? A-Review medications B-Folic acid female diagnosed UC 6 years age came with concern about cancer screening A - 8-10 years after diagnosis Patient diagnosed with UC when to be screened for cancer? A-Annually till age of 50 B-If there is mild inflammation C-At time of diagnosis D- 8-10 years after diagnosis Patient selection and timing — In all patients with ulcerative colitis (UC) and Crohn disease (CD) involving one-third of the colon or more, we perform screening colonoscopy eight years after disease or symptom onset to initiate surveillance for colorectal neoplasia pt recently diagnosed with HCV . came to start anti HCV treatment has viral load of 2 milion. no liver cirrhosis signs. Labs shows only mild elevation in Liver enzymes what to do next 1- Give Peg interferone 2- Entecavir 3- Sofo/ledi 4- discharge and see result after 3m Pt reNNNEXT cently diagnosed with HCV. came to start anti HCV treatment has viral load of 2 million. no liver cirrhosis signs. Labs show only mild elevation in Liver enzymes. what to do next 1- Give Peg interferon 2- Entecavir 3- Ledipasvir-sofosbuvir 4- discharge and see result after 3m 24 years old male complain of Dysphagia to liquid more than solid , what investigation will help you to reach the diagnosis ? A- 24 Ph B-Barium swallow C-Endoscopy 24 years old male complain of Dysphagia to liquid more than solid , what investigation will help you to reach the diagnosis ? A- Manometry B- 24 Ph C-Barium swallow D-Endoscopy Patient presented with dysphagia to liquids more than solid Which is the most appropriate initial investigation? A- endoscopy B- barium swallow C- US D- biopsy 13 of 51 Mother has her first child and he turned out to have sickle cell disease. She has since remarried and what’s to go for premarital testing. What is the first test you should do? A- Paternal hemoglobin electrophoresis B- Paternal chromosomal analysis C- Maternal hemoglobin electrophoresis D- Mixed biomarkers or something vague like it A Women came to clinic she’s divorced and will marry again. asking about the chance of getting another SCD child. She has SCD child from her pervious husband. Which of the following is most appropriate in her case? A- Paternal hemoglobin electrophoresis B- Paternal chromosomal analysis C- Maternal hemoglobin electrophoresis D- Mixed biomarkers or something vague like it 9months infant mom started solid but until now still depend on breast milk . What to do : 1- iron supplement 2- advise mom to faster the solid food introduction RTA patient with lower back pain and spinal injury has not ruled out yet you are waiting for the neurology consultation what are you suppose to do before other investigations ? 1- pelvic binders 2- movement restriction 3- CT 4- spinal binder 12 years old found to have klebsiella with in 100,000 colony from mid stream urine, no sign or symptoms 1- no need for treatment 2- treat as acute UTI 3- give ABx as prophylaxis 4-repeats culture post hernia repair with mesh, advise to : 14 of 51 1- 6months laxative 2-6months avoid heavy lifting Pt with infertility and there is frank galactorhea come from the breast what you have to investgate 1-Prolactin in the serum 2-TSH 8 days old newborn for diabetic mother came with SOB and cyanosis, looks irritable and ruddy, no flu like symptoms RR 40-49 HR 169 Hb 24.1 (normal: 165-175) 241 not 24.1 Hct 0.75 Plt 120 Whats the diagnosis? A. Polycythemia B. RDS 8 days old newborn for diabetic mother came with SOB and cyanosis, looks irritable and ruddy, no flu like symptoms RR 40-49 HR 169 Hb 24.1 (normal: 165-175) 241 not 24.1 Hct 0.72 low Plt 120 What is the most appropriate next management? A. Echocardiogram B. Partial exchange transfusion ((definitive bc more than 75 HCT + symptomatic)) C. Hydration, oxygenation, suction ((( initial next step))) Surgeon presenting a new surgical method And he changed some facts to decrease error resulting from these methods and to convince the audience What did he do? A-plagiarism B-Falsification C-Fabrication Forgot the 4th At what age in months children typically manifest anxiety towards strangers? A. 3 B. 6 C.8 D.12 15 of 51 A child starts to develop an awareness for strangers and separation anxiety. How old is the child in months? a. 6 months b. 7 months c. 12 months d. 24 months • Stranger 6 • Separation 9 Pregnant smoker she couldnt stop smoking what to give? Better recallS : pregnant smoker useful tool for smoking? A- Bupropion B- Varenicline C- Behavior therapy D- Nicotine replacement therapy Pregnant wants to quote smoking best way A. CBT B. Nicotine replacement C. Buprine Best way to stop smoking in pregnant is : a. Behavioral way b. bupropionA c. Electronic smoking d. Alternative to smoke Pt involved in RTA ( i think ) came to er vitaly stable what to expect in FAST? Free fluids male involved in RTA in ER he is fully conscious and no abnormality in vital signs admitted for observation and a FAST scan done ,.what do you expect to find a. pneumothorax b.major vessel bleeding in the thorax c. Intra peritoneal fluid Preterm male with low weight 1300g and has bloody stool. He was diagnosed with necrotizing enterocolitis: Which of the following is a risk factor for his condition? A- male gender B- low weight C- bloody stool Air in bowel wall; necrotizing enterocolitis (infection), risk factors; Premature, Weight below 1500g menepause accidentally during examination we see 3rd dgree prolapse no urine incontenance what Tx? Elderly with 3rd Dgree pelvic organ prolapse she is completely Asymptomatic , discovered during regular check up what is the most appropriate for her? A- observe B- surgery (related to organ prolapse) C- TIBSO and hysterectomy D- give her hormone therapy UTD: Indications for treatment — Treatment is indicated for women with symptoms of prolapse or associated conditions (urinary, bowel, or sexual dysfunction). Obstructed urination or defecation or hydronephrosis from chronic ureteral kinking are all indications for treatment, regardless of degree of prolapse . Treatment is generally not indicated for women with asymptomatic prolapse 16 of 51 Pt with liver cirrhosis have UGIB what to give before endoscopy A- octreotide Cirrhosis with massive hematemesis, became drowsy and blood oozing out from his mouth: next step of management A-Blood transfusion. B-Endotracheal tube C-Inj octreotide 56 years old patient had an upper Gl bleeding due to esophageal varices and was given IV fluid. Which of the following should be given to reduce mortality? A. Vasopressin B. Octreotide C. Nadolol D. Ceftriaxone A 67 years old man with a known history of HCV cirrhosis admitted to the ER with a massive hematemesis. Variceal bleeding is suspected. On examination, he is drowsy with tense ascites. BP 110/70, HR 86, So2 95%. Hb 8, INR high. Which of the following management options has a great benefit in reducing this patient's mortality? A. Octreotide. B. IV Ceftriaxone. C. Blood transfusion. D. Pantoprazole infusion. • Reduce mortality = IV ceftriaxone • Prevent re-bleeding = BB • Before endoscopy what will you give = Octreotide Patient multiple trauma post RTA had to undergo open laparotomy because he was hemodynamically unstable. Liver has multiple laceration what's the most appropriate step? A. Perihepatic packing. B. Hepatic resection C. Partial hepatic resection with splenectomy Trauma multiple liver laceration asking about most appropriate management not initial. A-perihepatic packing B-right hepatic artery ligation C- individually ligate bleeding vessles Laparotomy with multiple liver laceration management? A. Perihepatic packing. B. Right hepatic resection C. Vessels ligation Pringle maneuver: clipping the vessels during surgery to identify the source of the bleeding and for hemorrhagic control. (Temporary) RTA patient came to ER and goes throught exploratory laprotomy and you find multiple laceration of liver, patient is unstabel What will you do : A-right hepatectomy B-prehepatic packings C-right hepatic artery ligation D-individual hepatic artery ligation Patient received 15 units of blood and started bleeding from ngt and puncture sites and other places, what's the. Cause : A. Hypocalcemia 17 of 51 B. Thromcytopenia C transfusion reaction D Von willbrand Pregnant known diabetic 40weeks un eventful pregnancy, sudden fetal death, fetus was 2.6kg no obvious anomaly, placental sample showed thrombi, what's the cause of the fetal death: A. diabetes B growth restriction C placental abnormality D I forgot maybe hypoglycemia Long senario of a girl with alot depression symptoms and suicidal attempts, the doctor said she needs to be admitted and she got very angry What's the ethical principle behind wanting to admit the patient A. Justice B. Beneficence C. Non malificence The fourth option was really not related A traumatic pt lost 25% of his blood..which of the following is the most suspected to be effected first A-Urine output. B-Pulse pressure C-Respiratory Rate. D-Glasco-coma scale patient lost 25% of his blood, what is expected to be decreased… ? i think the question means significantly A- urine out-put B- respiratory rate C- GCS D- Pulse pressure Patient with chronic liver disease with acitees, came to clinic c/o reducable umbilical hernia, he only stated discomfort no other symptoms, most appropriate management: A. Paracentesis then open repair B. Wait for ascites to resolve C smth with mesh Pt have liver cirrhosis with ascitis and present with umblical mass Hernia reducible and uncomfortable with that what next A_ do operation immediatly B_do paracentesis and after that direct do operation C_dont do operation D_dealy untill ascitis controlled 60y pt with chronic liver disease and acitest came complaining with umbilical hernia How to treat it ? A -Laprscopic hernial repair B -Repair with waterproof mesh C -Wait till acietest treated first D -Do paracentesis and repair UTD: “Prior to surgery, ascites should be minimized as much as possible with medical treatment.” Patient on depression medication, c/o perianal pain (am not sure) , and other other urinary tract symptoms, he cannot pass urine for the past 12 hours , A . Prostitis B. Bph 18 of 51 C. Neurogenic bladder I forgot the last option Pt of RTA , he was treated in a small hospital, his vitals were stable, clear lungs He did x-ray there was no pneumonia but there was wide mediastinum You are gonna transfer him to a hospital that's 40km away, what will u do: A. Chest tube B. CT chest C.? D. Call the on-call surgeon 40 Year-old male presented the emergency department with chest pain radiating to the back. Most probably aortic dissection ( No vitals were provided in the question) A- Echocardiography B- Ct angiograhy C- cardic isoenzymes D- Abdominal US Wide medistenum= aortic dissection Diagnostic: CTA (gold standard) This is my paraphrasing: a patient was being prepared for a surgery or a procedure , and there was something that was not steralized properly, the nurse noticed and said stop now " .... Was not properly steralized" What's the type of communication used : A. Check back B. Call out C critical language D. Closed loop communication 19 of 51 Woman delivered after she delivered the placenta she lost 1000cc of blood, uteres is firm , she is alert and I think was stable ( no labs no other details in the question) A. Atony ((Soft, enlarged, boggy ascending uterus = atony)) B. coagolapathy C retained products of placenta D. Genital laceration Woman with dysuria, allergic to sulfa and penicillin what will you give her : A. Tmp- sulfa B. Nitro C cefalaxin D.ampicillin 20 of 51 1-Plasma volume in 15 weeks pregnant ? A. 20% increas B. 40% 2-Pregnant in her 15 GA came for Follow up, expected to have : A- decrease Hemoglobin 20% B- decrease hemoglobin 40% C- decrease plasma volume 20% D- decrease plasma volume 40% 3-Pregnant GA 15 weeks, what changes will happen ? A-plasma volume increase by 20% B-plasma volume increase by 40% 4- Same preveus Q bu with was in 1st trimester,was choics : A- Increase hematocrit B- Increase plasma volume 20% C- Increase plasma volume 40% G1 p0 at 28 wks gestation presented with membrane rupture 24h ago what is your management ? A- Observation B- IOL C- emergency section D- Or amnioinfusion Patient past history ihd, c/o sob not very severe goes with embolism His bmi is 40 What do you give him A- Ufh 5000 B- Ufh 7500 C- Enaroxpan 40 D- Fondaparinux AMBOSS : UFH o Preferred in patients with unpredictable subcutaneous absorption (e.g., patients with obesity, hypoperfusion) Young Patient with solitary tender nodule on side of vulva : A. Furncle B. Bartholin cyst abscess correct ( Bartholin gland abscess) C. Vulvar abcess postmenopausal woman compaling of 1 year hx of recurrent vulvar itching associated sometime with blood streak secretions , recently devolop pea size mass in the labia? a) bartholin cyst b )cystic adenosis c) bartholin gland cancer d) squamous cell cancer of vulva What indicates upper urinary tract infection : A- male B- duration of fever C- vomiting D- temperature 21 of 51 Baby burn on his genitalia 3rd-degree estimated 1% A. Refer to burn center B. Dressing as outpatient C. Sterile wound as inpatient A baby of 12 years diagnosed with end-stage cancer, unfortunately, mets to the femur and backbone DNR accepted by the doctor What is your management to help at this stage A- morphine B- Intitrope support C- Mechanical ventilation support D- Nothing to do Multiple vomiting : Metabolic alkalosis with hyperkalemia Metabolic alkalosis with hypokalemia 40y female k/c DM , what HTN treatment u will give her ? A- ACEI best ttt among DM drugs for decrease wt ? A-Metformin B-GLP DM obese on life modifications his Alc 8 what to add A-dulaglutide V is also GLP B-DPP-4 inhibitors; C-GLP-1 receptor agonists D-SGLT2 inhibitors; ANSWER: ALL is effective in weight reduction but LP is best outcomes, Uptodate: For patients in whom ASCVD predominates, particularly in the setting of higher A1C or motivation to lose weight, we typically prescribe liraglutide, semaglutide, or dulaglutide. 22 of 51 ️old male pt has HTN DM , currently have sever sudden abdominal pain , what most likely Dx ? A-Mesenteric artery thrombosis/occlusion 66yo man, worsening abdominal pain over the last week, the pain started as vague lower abdominal discomfort associated with nausea, anorehia and constipation, this morning he has sudden severe lower abdominal pain accompanied by lightheadedness and an episode of vomiting, the pain initially improved but then gradually intensified to involve the entire abdomen, his medical history is significant for coronary artery disease and appendectomy, bowel sounds diminished, the abdomen is diffusely tender with guarding and rebound tenderness, abdominal imaging is most likely reveal which of the following findings in this patient? a. dilated small bowel with a transition zone b. embolic occlusion of the mesenteric artery c. free air in the peritoneal cavity d. hematoma surrounding the abdominal aorta pt has systolic harsh murmur radiated to carotid artery increase w/ pending forward A-ASD 58 years old male patient had Myocardial Infarction 6 weeks ago , presented to the ER with dyspnea cough and frothy sputum with harsh systolic murmur heard over the precordium what is the diagnosis? A- PE B- Tricuspid regurgitation C- papillary muscle rupture D- ASD Patient has MI 6 weeks ago now he presented with dyspnea cough and frothy sputum with harsh systolic murmur heard over the pericardium what is the diagnosis? A- PE B- Tricuspid regurgitation C- papillary muscle rupture D- can’t remember MI anterior or inferior will lead to ischemia in Papillary muscle as it attached to inferior to septal wall , Ischemia with the time healed with fibrosis >>> rupture later >>> MR >>> blood back to lung >>>> pulmonary edema >>> frothy sputum… pt has mid diastolic murmur ? A-Ms Mid diastolic murmur at Apex +Rumbling in nature & Increasing intensity in Expiration+Best heard in left lateral decubitus position+ Loud S1+ Tapping apex beat= Mitral Stenosi Hyperkalemia , the ECG will show ? A-Tinted T wave B-Tinted p wave pt has chest pain for take >20 min not relieve with rest Trop I +ve no ECG changes , what’s the Dx ? A-Unstable angina B. Stable angina C. STEMI D. NSTEMI Question about depressed ST but normal cardiac enzymes? A. unstable angina B. Stable angina C. STEMI D. NSTEMI 23 of 51 pt post viral infection, currently has hematuria , what’s the Dx ? A-GN B-Allergic interstitial nephritis • Depends on the duration • If early > IgA nephropathy • If late “3 weeks” > PSGN tumour lysis syndrome scenario , what’s the metabolic disturbance ? A-Low phosphorus B-High ca C-High potassium High K, high Ph, low C female pt has a Hx of DVT treated , what u will give her ? A-Warfarin B-Enoxaparin C-Heparin D-No need If she have a factor risk then > enoxaparin If don’t so it will ( no need ) most common case of bleeding per rectum ? A-Colon ca B-Angio dysplasia C-Diverticulosis when u will repeat h.pylori after Triple ttt ? A-1w B-2w C-1 month old pt post op admitted on ICU for 2 w , right now He complaining of abdominal pain , what’s the Dx ? A-Stress ulcer middle age man c/o caugh hemoptysis on examination : no shifted trachea and x ray shows Lt pleural effusion , what the Dx ? A-Tubeurcla effusion B-Lung fibrosis C-Lung ca Middle aged + cough + hemoptysis + no fever+ uni lateral effusion (exudates) = lung cancer !!!!! old pt smoking 1 pack for 30 y , c/o : productive cough , SOB , no loss of wt and other signs/symptoms of cancer , Dx ? A-Emphysema B-Chronic bronchitis C-Lung cancer 24 of 51 UTD : Chronic bronchitis — Chronic bronchitis is defined as a chronic productive cough over a defined period, classically for at least three months in each of two successive years, in a patient in whom other causes of chronic cough (eg, bronchiectasis) have been excluded . It may precede or follow development of airflow limitation . This definition has been used in many studies, despite the arbitrarily selected symptom duration. By age 35 to 40 years, cigarette smokers may develop chronic bronchitis and start to have intermittent exacerbations of their symptoms even in the absence of airflow obstruction 14 y male of has eczema , what the commonest site ? A-Flexor B-Face and Cheek C-Extensor • Answer is: A FLEXOR, why? He is 14 yrs old • Face for babies below 6 months • Extensor for peds from 6months to below 5 yrs • Eczema location per age group: ▪ <6 months = face scalp ▪ 6m - 2y = ext. surface elbow knee ▪ 2y - 5y = same as above + hands wrist mouth eyes ▪ > 5y = FLEXOR surface pt w/ CNS manifestations MRI shows : A-neuritis B-MS Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanium No loss of consciousness, no vomiting , neuro exam Normal Ear : Ruptured tympanic membrane with intact external auditory canal Most likely bone fracture: A-Mastoid B B-Maxillary C-Basal skull child with supracondylar fracture and absent of pulse , what’s the initial step? A-Conservative B-ORIF = Open reduction and internal fixation 25 of 51 C-reduction 12 year old boy injured with supracondylar fracture and distal radial pulse absent , which of the following is the appropriate next step in management? A-K wire B-intramedullary nail C-surgical exploration D-Closed reduction old male patient with Lt inguinal hernia , how u will ttt ? A-Open herniotomy B-Laparoscopic operation middle age pt Dx as b/L hernia ? A-Laparoscopic harniotomy Adult hernia cases are repaired through hernioplasty , except in : bilateral and /or recurrent, obese Open repair is preferred If previous repair was open, go for laparoscopic on the opposite is true Surgical indications : In Complicated hernias : Incarcerated irreducible obstructed sbo only (constipation ) strangulated : ischemia necrosis , skin is tender red Non surgical treatment is preferred in asymptomatic or very minimal sx without signs of complications Except for : femoral hernia in adults is treated surgically in all cases even asymptomatic ones Inguinal hernias is children (herniotomy ) post sleeve 3 days , pt came to ER C/O : abd pain , what u will do ? A-US B-CT knife stabbing on zone 3 of the neck , how u will treat it ? A-Endo vascular repair MVA c/o: chest pain , SOB and absent Lt chest sound ,what u will do ? A-Chest tube pt Dx as ureteric stone 4mm first time visit ER , what ur treatment ? A-Conservative B-Do operation 26 of 51 child pt in low socioeconomic status with large abdomen , what is the cause ? A-Sever protein deficiency (kawashoirkor) B-Sever carbohydrates deficiency (marasmus) Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: decreased glucose, decreased albumin A. severe protein deficiency B. severe carbs deficiency C-Rickets D-Mild manutrition parents warring about their child tall and asking his tall will be like even after puberty , what’s the miss information here ? 27 of 51 A-Siblings heights B-Parents heights 40y women I think with Hx of DVT need to control her birth ? A-Condom B-IUD C-Patches D-OCP 40y women G4P4 , her last daughter age 8 And LMP before 6 month , what u will check ? A-FSH B-TSH Recall : A 45 year old woman with 6 months amenorrhea wants to get pregnant what do order : A- FSH and LH B- Endometrial biopsy preg women has vaginal bleeding , some fleshy content passed , on examination : open os U/S: show beats , Dx? A-Incomplete abortion preg women has vaginal bleeding , denied any content passed away , on examination : open os , visible/palpable something U/S: show beats , Dx? A-Inevitable abortion 1)Patient with severe abdominal pain with menstrual cycle (dysmenorrhea), affecting her work, what can you give? A-Misoprostol B-Paracetamol C-Progesterone D-OCP 📝📌Note to remember (ACOG) Management of Primary Dysmenorrhea - NSAID (first line) - OCP (second line, if a trial of NSAIDs does not provide adequate relief of dysmenorrhea symptoms) Patient present with cottage cheese like vaginal discharge, itching and urinary symptoms, Asking about the treatment? 28 of 51 A) topical estrogen B) topical antibiotic C) oral anti fungal D) oral antibiotics Vaginal yeast infection - Clinical presentation: White, crumbly, and thick (cottage cheese-like) discharge. Odorless - Microscope: Pseudohyphae on KOH - Treatment: Topical azoles or nystatin or Oral fluconazole Topical if she’s pregnant Oral if she’s not pregnant Female with vaginal discharge Grey, fishy odor, smear show clue cells, diagnosis? A. Trichomoniasis B. Bacteria vaginosis C. Candida Bacterial vaginosis - Clinical presentation: Gray/milky discharge. Fishy odor - Microscope: Clue cells - Treatment: Metronidazole - Post-menopausal women present with itchiness and odorless discharge with vaginal excoriation what is the diagnosis? A- Candidiasis B- trichomoniasis C- vaginosis D- atrophic vaginitis Child with croup recevied epniphrnie and he improved. What next? A. Antibotic B. Steroid Pediatric patient diagnosed as croup in the ER, he was given the proper management, but after 1 hour he did not improve. What is the appropriate management? A-exposure to cool humidified air B-prednisilone (with dose) C-dexamethasone (with dose) D-racemic epinephrine Child with croup recevied epniphrnie and he improved. What next? A. Forget B. Prednisone 0.2 C. Dexamethasone 0.05 D. Ventolin D Child 6yrs old presented with history of 6month left knee and wrist pain with limitations of movement and especially morning difficulty movement Otherwise no systemic symptoms What is the most likely diagnosis? A. rheumatic fever B. reactive arthritis C. septic arthritis D. juvenile idiopathic arthritis infant exclusively breastfed then was given cow milk, now at 9 months after introducing some iron, containing food , there’s still a concern that the infant, isn’t recovering enough iron what would you do? A Add iron supplements 29 of 51 B Switch to formula C Stop cow's milk completely D-Add Vitamin 18 month present with abdominal bloating and loss of subcutaneous fat..what diet should u prescribed ? A. High calorie B. Gluten free C. Partial hydrolysed formula D. Forget the option Growth chart indicating failure to thrive. 4 years old child came post URTI 2 days ago complaining of SOB Wheezing, RR 33, HR 100, 02 82% other vitals normal (not sure. Parents said that he had multiple previous hospitilization due to same reason. What is mangment ? A. ABx and systemic steroid B.IV fluid and ventolin C. Yentolin and systemic steroid D ABx with nebulizer ventolin [look like asthma case triger by viral infection >SABA and systemic steroid ] 2 year old child presented after a viral infection 2 weeks ago (or days I forgot), he presented complaining of SOB, and dyspnea, upon examination he has wide spread crepitation and prolong expiratory wheezing, she had similar attacks in the past that lead to (they didn’t say he has a history of asthma), what is the management? I think he was slightly hypotensive But O2 sat was low A- antibiotics and fluids B- steroids and B2 agonist C- fluids and steroids Child 12 years old complaining of abdominal pain since 1 year and sometimes heartburn, other wise he is completely normal, his mother have hx of chronic abdominal pain? A-Omeprazole B-Steroid C-Azithromycin D-Hypoallergenic diet Case of Eosinophilic esophagitis Child with epigastric pain, heartburn..., mother has the same problem, best to confirm? A-Endoscopy 1-year-old child came with fever and cough for 4 days. URTI presented with increased hypoxia and severe respiratory symptoms, in auscultation, there were fine crackles in the bilateral lungs and Puffy infiltrates in both lungs what Dx? A) Bronchopneumonia B) Cystic fibrosis C) Tuberculosis D) Bronchiolitis If no Bronchiolitis in choices, then it is Bronchopneumonia 30 of 51 4years old came with URTI, high fever, drooling of saliva and multiple enlarged lymph node. He dod not receive any vaccine Which of following vaccine might prevent this condition A-Hemophlius B-Streptococcus C-Diphteria D-Polio Non-immunized pts Drooling of saliva= Acute epiglottis = H.influenza Type B Drooling of saliva+ enlarged LN= Diphtheria = Diphtheria toxin Low grade fever= Croup High grade fever= Acute epiglottis, Diphtheria, Bacterial Tracheatitis. 10 year old child presented with abdominal pain and diarrhea sometimes bloody, he had weight loss in the last 3 months, he also complain of joints aches and pain, on exam he looks pale Laps: Na low K low Hg 8 Albumin low What is the most likely diagnosis? A.Celiac disease B.Cron’s disease C.Ulcerative colitis D.Colonic dysentry Patient with vaginal bleeding, and the diagnosiswas Uterine fibroid What is that most common site? A-cervical B- Intramural Most common uterine fibroid location? A- Submuocus B- Intramural C- Sub serosal Most common fibroid: Intramural Most common type of fibroid that causes BLEEDING: Submucosal Case with signs of suden onset intestional obstruction? A-Hernia B-Mekel’s diverticulium 24 years old male, medically and surgically free , presented with manifestation of intestinal obstruction, suspected to be small bowel obstruction What is the most common cause A) adhesion 31 of 51 B) Meckels diverticulum C)Malignancy The commonest cause of small bowel obstruction in people with previous abdominal surgeries, is adhesions. In patients with virgin abdomen, it is hernia. Case with 6 h abdominal pain, vomiting once , by examination, mild suprapubic and lt illic fossa tenderness A-Discharge with analgesics B-CT abdomen Yellow white vaginal discharge ,, +ve leucotye , Rx A-Metronidazole B-vaginal culture Case of painful defection with failed medical treatment ,, A- Lateral intermiontoy -Patient complaining of pain during defection (Anal fissure ) what you will do for her ? A. anal diltation B. Diltiazem Cream initial management C. Botox injection D. Internal lateral sphincterctomy most effective treatment for anal fissure after failure of medical management Botox injection :in case of failure of initial medical management in patient at risk of fecal incontinence Age to introduce peanut base and egg option was A-10 B-12 Recommendations that at which age you can give a peanuts and eggs to the Child will decrease production of allergy? Age in month A 10 months B 14 months C 20 months D 24 months milestone question came to clinic w parent dr ask him to throw ball and he catch it back , draw straight line option was A-15 B-18 Age of start iron supp is A- 4 month mother notice rice like in baby diapers: Answer is Something vermcularis The ministry of health do an activity for observe and gather the other health authorities something like this option was : 32 of 51 A. Active surveillance B. Infection control C. Primary prevention D. I forgot the 4th coarctation of aorta common in ? A- Turner Patient 12 years old with HTN and DM and dyslipdemia on medication which of the following has the greatest impact to decrease BB in this case ? 1-physical activity 2-smoking cessation 3-DASH diet ( low fat , high fruit and vegetables) immunodeficiency wht vaccination is contraindicated ? Option was A. Varciella B. IPV parotid swelling option was A. Mumps B. EBV Post RTA unconscious multiple face fracture and sign of brain injury all vitals stable fist thing to do? A. Secure airways B. Stabilize cervical spine C. Blood transfusions D. Iv fluid Pt Dm2 on diet and exercise control , recent HBA1c is7,2 What to do ? A. Reassure him B. Start metformin C. Tell him that he’s at high risk of heart disease multiple laceration what's the most appropriate step? A-Perihepatic packing Risk factor for osteoporosis? A. Hypercalcemia B. Short period using NSAID Child history of knee and wrist pain with limitations of movement diagnosis? A. rheumatic fever B. juvenile idiopathic arthritis 8 yrs old failure to thrive in divorce parent , lives w mother and she’s on antidepressants medication what to do? A. Reassurance B. Increase caloric intake 33 of 51 Contraception in female complain of heavy menss option was ? A. mirne IUD B. COC C. progesterone pills Definitive tx of urine incontenanc ? -Vaginal free tape Old pt came with Rt leg pale & absence of peripheral pulse , irregular irregular radial pulse , what is the source of thrombus ? A- Lt atrium B- thoracic aorta C- abdominal aorta Pregnant lady with active hepatitis b , What will you give tha baby after birth ? A- hepatitis b vaccine B- hepatitis b vaccine and IG C- IG Pregnant lady with leg swelling and sing of DVT , SOB what best the next ? A- chest X-ray B- Doppler US What may indicate UTI in lab results ? Nitrit child on inhaled corticosteroid with picture of candidiasis oral infection. How to treat? A ⁃ nystatin B ⁃ Itraconazole C ⁃ Amphotericin frank galactorrhea in 35 yr old lady with irregular menses. Next investigation? A ⁃ thyroid B ⁃ Prolactin C ⁃ Forgot ethics : pt need bypass cabg operation after no use from theombolytic and pci. She is not concious. Husband out of city and need consent from him A⁃ wait for him B ⁃ Take consent by phone C⁃ Let him choose a local guardian till he arrives definitive management for adenomyosis? ⁃ hysterectomy child can hold head but need support for sitting and can reach mouth A⁃ 3 months 34 of 51 B ⁃ 7 months 50 yr old on metformin and gliclazide. Hbalc 5.8 and other labs normal. Asked what to do A ⁃ reassure B ⁃ Tell him he has increased risk of cvs resident examined pr abdx without closing curtain A ⁃ dignity B ⁃ Privacy child new onset strabismus ? A ⁃ call neurosurgery immediately B⁃ Refer opthalmo peds next day 7 yr old with pubic hair rest normal A⁃ normal B ⁃ Prepubertal adrenarche C ⁃ Cah asthma exacerbation with high co2 ? A ⁃ intubate qs on crohn most common site A ⁃ colon B ⁃ Rectum C ⁃ Ileum D ⁃ Jejunum scenario dvt prophylaxis in CKD A⁃ stockings B ⁃ Enoxapain C⁃ Ufh pt on amitryptiline at night 30 mg and gets dizzy morning. Manage ? A ⁃ divide doses B ⁃ Forgot the rest chronic hep b for review, asymptomatic but high lfts. Manage? A- observe B- entecavir ethics: what to do before conducting a research - ethical review on proposal prego with moderate dull pain, US showed 4 cm cyst A- observe B- cystectomy C- laparotomy D- laparascopy HIV wat vaccine not to give 35 of 51 A- varicella B- hep b C – dtap Case of cirrhotic patient having esophageal varices and presented with upper GI bleeding. Hemoglobin was 8.5. What is the most appropriate next step after initial fluid resuscitation? A- blood transfusion B- Upper Gi endoscopy C- Nasogastric tube insertion Subclinical hypothyroidism case. Examination: no goiter. Labs: TSH: 15 (high), T4: 6 (within normal limits). Most appropriate next step? A- US of the neck B- Start thyroxine replacement Patient with absent fetal heartbeat on ultrasound, which of the following is best to use for chromosomal analysis? A- Umbilical cord sampling B- Amniotic fluid C- Fetal cord blood D- Placental tissue 27 years old healthy male presented with right sided weakness. He has significant femur fracture 1 week ago. 2 days ago has pulmonary embolism. Brain imaging shows left cerebral infarction. Which of the following is the most likely the cause of his presentation? A. Atrial fibrillation B. Carotid artery stenosis C. Patent foramen ovale D. Hypertrophic cardiomyopathy Typical presentation of tension headache. The patient was playing games more than 3 hours and he sleeps lately. What is the most appropriate action? A- Paracetamol B- Reassurance C- Lifestyle modification Case of clear turner (no doubt), hight in the 5th percentile and wight in the 90th A- constitutional stature B- endocrine stature C- syndromic stature 8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy? A- Perianal B- Pelvic floor C- Rectus muscle D- Detrusor 8 yrs old failure to thrive in divorce parent, lives w mother and she’s on antidepressants medication what to do? A. Reassurance B. Increase caloric intake 36 of 51 Other option was not related 39 weeks of gestation, gush of fluid how Confirm amniotic leak: A. Methylene blue stain B. Another stain C. Ultrasound assessment D. Microscopy of ferning cells Pt with Productive cough. Pain in the chest. Blood in their sputum. Weakness and fatigue. Which has highly diagnostic? I think pt with TB so .. a. Zein nelson stain b. Thin blood film c. Thick blood film 41 week pregnancy primi came for follow up.. NST .normal study no maternal comorbidity ..next step a) induction of labour by oxytocin (Induction of labor by oxytocin at 42 weeks of pregnancy.) b) induction of labour by Arm c) follow up in 7 days d ) don't remember A mother comes with her 9-month old baby girl. She took all vaccines and now comes for the planned vaccinations of 9 months: A measles, mumps, rubella B measles, meningococcal conjugate C Hib, dtap D last option is wrong CDC : Haemophilus influenzae type b (Hib) vaccine and Diphtheria, tetanus, and acellular pertussis vaccine (DTaP) are recommended at 9 months of age A 10-days old boy presents in the ER after circumcision with 5-hours of bleeding from the operation site, what is the best step to do? A applying pressure on the operation site B exploratory surgery C blood transfusion D not relevant A 12-year old boy presents on the outpatient clinic with sob during playing football. Patient needs sometimes to stop playing to regain his breath. Physical examination shows healthy pt with expiratory wheezing bilateral, what is the best initial therapy: A inhaled corticosteroids B Albuterol C salmeterol D montelukast Patient presents on the outpatient clinic for following up his DM2. His history is free except DM2. He is ok metformin (forget the dosis) two times a day. Hba1c is 6.9. What is the best thing to do: A increase metformin dose B same management C add gliclazide D add insulin 37 of 51 A 32-year old woman G6P5 presents at 38 week of gestation with labor. After delivery of the fetus and the placenta, she starts to bleed profusely, what is the risk factor for the postpartum hemorrhage: A. parity Forget other options but I think that this is the correct answer between the other options Female multi gravida just delivered a baby weighing 3000g after 16 hs, Which of the following is a risk factor for developing postpartum hemorrhage? A. Fetal Macrosomia B. Prolonged labor C. Grand parity Female patient just delivered a baby weighing 3000g. Which of the following is a risk factor for developing postpartum hemorrhage? A) Fetal Macrosomia B) Precipitous labour C) Grand parity For conclusion: Grand multiparity: patients who have had ≥5 births (live or stillborn) at ≥20 weeks of gestation. Long duration of labor: Prolonged labor requires that, in the face of regular uterine contractions, the cervical dilation is <6 cm for a duration of >20 h in a primipara or >14 h in a multipara. in this case, it is 16 hrs in a multipara women, which is abnormal. Marcoscomic baby: 3000 g (which is normal). Macrosomia is >4000-4500g Multiple gestation: The patient is delivering one baby only. There is no mentioning of twins. Male patient presents at the ER after MVA and starts to shouts at the medical staff due to acute right pleural pain and right limb pain. Given vitals are still stable (at the edge of being hypotensive, tachycardic, tachypenic), what is the first thing to do: A establish IV access B CT scan of the chest C pain killers D ultrasound of the right limb According to the American College of Surgeons, establishing IV access is a critical first step in the management of acute pain in trauma patients Child with meningitis symptoms. Culture reveals bacterial infection, what do you expect to see in the CSF: A increases leukocytes, decreased glucose, normal protein B increases neutrophils, normal glucose, increased protein C decreased neutrophils, decreased glucose, increased protein D increased neutrophils, decreased glucose, increased protein A 12-year old boy presents at the ER with neurological sx (not sure). Pediatrician wants to do lumbar puncture, from where should he take consent: A form parents and patient assents B from patient and parents assent C from both parents and patient D no need because it is emergency Young lady, not married with hirsutism, pcos (and high BMI, not sure) presents after multiple failed cosmetic treatments. What is the first line pharmacotherapy to be prescribed? A metformin B coc Forget other options, and I don’t know if they’re relevan 38 of 51 Young female patient presents with migraine headache sx like unilateral, lasting few hours, photo- and phonophobic What is the best medication to prevent such headache episodes: A paracetamol B sumatriptan C ibuprofen Forget last option, but it is not beta blocker 14-year old girl with anorexia nervosa admitted to the hospital for ENTERAL feeding. On day 3 lab shows all electrolytes low (incl. Calcium, natrium, potassium and phosphorus). What is the reason behind this electrolytes findings? this patient have also failure to thrive A mistake in/not following enteral feeding protocol B refeeding syndrome C malabsorption D forget Male with known history of seizure and use of anti seizure medication (but he is nonadherent) presents to the emergency department with seizure sx What is the FIRST line management? The used anti seizure medication was not mentioned A valopric acid (not mentioned if it’s oral or iv) B benzodiazepines (not mentioned if it is oral or iv) C phenytoin infusion D forget but it is a medication without mentioning if it’s oral or iv Child diagnosed with thyroglossal cyst. The mass was on the midline of the neck with 1 or 2 cm in diameter. What is the management? A expectant B surgical removal C fine needle aspiration D forget Women K/C of liver cirrhosis, + ascites, confused. Na level: 126 (normal 135 to 145) Potassium level: within normal range Glucose: 8 (normal 3.9 to 5.5 mmol/L) A) Furosemide B) 0.45% Normal saline C) Normal saline D) D5 NS Gold standard for INTUSSUSSCDPTION A-CT CONTRAST B-ABD USS C-ABD X-RAY D-CONTRAST ENEMA AFTER ENDOMETRIAL BIOPSY IN A 27yr old and ATYPICAL HYPERPLASIA SEEN, next management A-TAMOXIFEN B-PROGESTRONE. ONLY C-OCP D-HYSTERECTOMY 39 of 51 A CHILD WITH AMBIGUOUS GENITALIA ( from the explanation) What’s the inheritance pattern A-Autosomal dominant B-Autosomal recessive C-X linked Commonest causes of tonsillitis in children A-CORONA VIRUS B-INFLUENZA C-RDV D-EBV A long case description of rheumatic arthritis, commonest heart valve disease A-Mitral stenosis B-Mitral Regurgitation C-Aortic stenosis D-Tricuspid regurgitation A case of cardiac surgery because of valvular defect, a known hypertensive also Bp 80/50, PR 120, .. temperature not given Cardiac output increased, reduced peripheral vascular resistance, asking type of shock A-Cardiogenic B-Hypovolemic C-Septic A 3yr old child with fever and cough , not Inip looking , nil shortness of breath, right lower lobe crepitation, temp 38 Which organism: 40 of 51 A-Morexell catarhalis B-Strept pneumonia C-Staph aureus A 7 yr old child with wheezing, SOB, cough , had initial admission for similar illness. Temp 36.6, Spo2 80 Best management A-Ventolin tablet B-Ventolin nebulisation + antibiotic C-Ventolin nebulisation + steroid D-Ventolin A 30yr old male involved in severe MVA ,sustained several injuries, conscious,told the doctors the story of the accident and how he was feeling , bp 70/50,Sp02 80 , appropriate next step A. IVF B. Blood transfusion D. Supplemental Oxygen A 55 yr old female a known hypertensive and diabetic, stable normal blood pressure and good glycemic control, bilateral lower limb pain aggravated after walking 500m but relieved at rest ., asking about possible cause A. Injury to the legs B. Peripheral vascular disease C. Varicose veins A case of 25yr old not sure but not upto 30yrs female with right Ovarian cyst . asking of best contraception for her A. Progestin only B. OCP C. Condom Antibiotics of choice for prophylaxis in Rheumatoid arthritis? A question about a hypertensive and diabetic on Enalapril, Aspirin, developed bleeding and swelling at the proximal and distal phalanges, asking for the drug that will likely cause it A. Aspirin B. Metformin C. Enalapril A girl of 13 yr old with short stature , has webbed neck asking of cause of short star tire A. Familial B. Poor diet C. Syndromic short starture The Q more features with teurner syndrome Apart from wbbed neck, other features of Turner’s syndrome was in the question patient with cirrhosis due to hepatitis C infection presented with ascites which not respond to repeated paracetesis Which of the following is the appropriate management a - restrict fluid intake b - avoid high protein diet c - avoid high glycemic diet d - restrict salt intake 39? y/o female patient with breast mass painless , mobile , firm , smooth no cyclic change 41 of 51 Dx ؟ a - ductal adnenoma b – fibroadenoma 30 s female patient ................. [ with suspicious breast mass on imaging ] most appropriate investigation : a - FNA b - core biopsy c - excesional biopsy case of post appendectomy carcinoid mass on histopathological [ small size ] appropriate management a - follow up b – hemicoloectomy case of post appendectomy carcinoid mass on histopathological [ 2*3 cm ? size] appropriate management a - follow up b - Right hemicoloectomy case of asthmatic child with frequent attacks education of concern a - immunization b -Spacer use c - avoidance of triggers Case of febrile UTI in child appropriate treatment a - ciprofloxacin b - amoxicillin c - i.v cefuroxime Case of child with parking cough , inspiratory and expiratory wheeze Concerned symptom : a - wheezing b - tachypnea c – cyanosis Case of child ( unvaccibated ) presented with proptosis , painful eye movement Dx a - preorbital cellulitis b - orbital cellulitis c - extraocular myositis case of CAH inheritance a - multifactorial b - AR c – AD which of the following is effective contraceptive method a - male condom b - female condom c - vaginal hormonal? ring d – spermicide 42 of 51 Case of 16 years old with pain relatedto menstrual cycle appropriate management : a – NSAIDs valvular intraepithelial carcinoma in situ Management a - valvectomy b - superficial excision Case of senile valvitis Management: a. topical estrogen cream Question about time of vaccination with live vaccine in pregnant : a-postpartum Case of cervicitis with sex partner diagnosed with gennorhea ----- Site of sample : a - high vaginal b – endocervical Case of alcoholic female patient with acute epigastric pain ( acute pancreatitis ) Investigation : a - procalcitonin b - aldehyde .... Case of child with coma , acidosis , dehydrated , CSF with high cellular and normal other components Dx a - ascetylacid poisoning b - Bacterial c – viral Old female patient with knee joint pain , swelling , mild fever , joint aspiration show( wbc = 260,000) , CBC ( wbc 12000 ) , X-ray show osteophytes ...... Dx : a - septic arthritis b - O.A c - Rheumatoid Arthritis Case of rheumatoid arthritis with dyspnea , cyanosis , clubbing >>> Dx a- lung fibrosis female patient with DM , HTN want to do Bilateral tubal ligation : a - patient consent b - both wife and husband consent c - patient consent and ask her to inform the husband d - preventative consent HBsAge +ve , IgM HBc -ve , HCV Ig G + ve >>> Dx 43 of 51 a - acute hepatitis B infection b - chronic hepatitis B infection c - previous hepatitis B infection d - post immunization you treat old age female patient .... relative give you gift of traditional meal a - accept b - inform the facility Administration c – refuse a child fall down from about 1 meter ? presented with skull fracture, Bilateral femoral fracture , skin finding?? ..... dx a - pathological fracture b - Barrter syndrome Doctor examine diabetic patient with students without closing the door a – privacy asthmatic child with frequent attacks ..... his father refused to stop smoking in the house ...... what to do a - ..... authority ? b - advise about vaccination asthmatic child .... of consern in education a - how to use the spacer Case of median nerve injury post stab wound in the shoulder... clean wound Management : a - immediate suturing In normal pregnancy what is expected to be decreased as far as I remember it was asking specifically about pt in 1st trimester: a-Uric acid b-Creatinine I don’t remember rest Pt came with rectal bleeding .dr did SIGMOIDOSCOPY OR ANOSCOPY i don’t remember which one and was positive of ulcer 10 cm from anal verge what is next to do ? a-Colonoscopy • Tumor lysis syndrome what is the electrolyte abnormalities? a-hyperkalemia hypocalcemia There is a q about someone who had MVA and came with neurogenic shock after resuscitation he improved what is the next step a- Iv crystolloid b-Blood transfusion 44 of 51 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Scenario of Infective Endocarditis post tooth extraction dx case about adenovirus infection post natal depression? Vaginal paoriases how to confirm? Where to place thoracocentesis? Pt with pentrated neck in third zone Ct showed avascular injury Tx? Paracetamol toxicity? Iron ingestion ( toxicity )? When is IUD contraindicated? diabetes millets with vaginal discharge , what’s the organism? premenstrual tension syndrome? electrolyte disturbance in pyloric stenosis ? And Best investigation ? hirshuspring case management ? Q ask about HCV grading they gave a sinario .. femur fracture in 4yrs …Tx? Barrett child syndrome??! Metochlopramide antidote? Some Q about ask what diagnosis : o Bacterial vaginosis o Trichomoniasis o Candida Two Q about shock porcelain gb management? acute cholecystitis management 24 hrs of symptoms ? near miss, q look a like q closed loop communication q how to write vit d order ? asthma: add ics to meds. Another qs was on ics and saba prn-> add laba scenario kwarahirkor ? positive reinforcement q for tantrum scenario dvt management ? the scenario abt meds when to take at 9 12 and 15 hrs ? vivax recurrence soldier going to somehwere for malaria prophylaxis dengue where most in ksa ? Management of placenta previa in 31w?? Vaccinations in preschool ? fracture case hint in the question (Battle sign )? Dx Monoclonic monoclonic time ? Opioid antidote ? Paracetamol toxicity ? What indicates UTI (NITRATE)? Gestational week and type of test for screening of Gestational diabetes ? case about molar pregnancy treatment ( diagnosis not given, but there is hunt in case : imaging showing snow storm appearance) ? Cause of PPH ? clear nephrotic syndrome scenario , need Dx clear as sun UTI scenario , need Dx? clear case of pancreatitis There was Qs about the stepwise approach of dysphasia 45 of 51 ? When u will give oral , or IV iron replacement • شركة هاتعقد مؤتمر عن شئ معين واحضرت دكتور اللقاء محاضرة مقابل مبلغ مادى... .Aيرفض .Bام يقبل .Cام يقبل لكن يكون له والء كامل للشركة كان فى سؤال طفل 7y hyperactiveو stresslessوبيتكلم بسرعة وعنيف فكيف نقلل المشاكل هذه : .. -preschool examination -decrease video games and television سؤال endometriosisمكرر ( صورة وحالة). سؤال التهاب مهبل جرثومي ماهو العالج؟ سؤال طفل تعرض لرد فعل تحسسي شديد بعد أخذ لقاح ماذا تفعل في الجرعة الثانية؟ سؤال امرأة حامل اسبوع ٨عنق رحم مغلق وكتلة جنينية ضمن الرحم وهناك نزيف مهبلي متوسط ،مانوع االجهاض؟ سؤال رجل لديه نزف هضمي سفلي غزير وحضر للطوارئ ،والخيارات نقل بالزما طازجة او تسريب نورمال سالين او تنظير كولون اسعافي او استئصال؟ سؤال رجل تلقى لقاح التهاب كبد بائي ولم يتعرض لعدوى مانوع االضداد المتوقع وجودها لديه؟ سؤال امرأة سلبية الريزوس وطفلها ايجابي هل يعطى anti Dلألم او للجنين او لألثنين او اليعطى ابدا؟ سؤال رجل لديه ساركوئيد لعامين ثم لديه anemiaماسبب فقر الدم؟ سؤال رجل لديه اصابة على مستوى الفص االيمن للكبد ونزيف غزير اليتوقف ..ماالتدبير؟ سؤال امرأة تريد التمنيع وزوجها يرفض ..كيف تتعامل مع ذلك؟ سؤال طفل يراجع بمشاكل تنفسية ووالده اليتوقف عن التدخين بجانبه و اليستجيب للنصائح الطبية ...كيف تتعامل؟ سؤال عن رجل لديه اعراض تنفسية ماهو االجراء االول الذي ستطلبه له؟ سؤال عن كيفية تحديد انذار ( copdنسبة ،o2عدد نوبات بالسنة ، fiv 1 ،نسبة ) fiv1/fvc؟ سؤال طفل بأعراض تنفسية ..ماالعامل المسبب؟ 46 of 51 Pictures Female with dyschazia, pain before menstruation and infertility and laparoscopy was performed (finding in the picture), what is the diagnosis? DX: A- adenomyosis C- PID C- endometriosis Dx: Sigmoid volvulous Newborn with jaundice at first 12 hour What the best investigation A.Coomb B.Osmotic fragility test C.Blood count with electrophoresis D.G6pd A neonate 12 hours after normal vaginal delivery noticed to be jaundiced. The blood film showed microcytic hyperchromic cells. The best investigation to order is: A) Osmotic fragility test. B) Pyruvate kinase level. C) Glucose 6 phosphate dehydrogenase enzyme. D) EMA Baby born sc full term asking about treatment? 47 of 51 asking about treatment? asking about diagnosis? Growth chart look like this And senario of. : 18 month present with abdominal bloating and loss of subcutaneous fat .. what diet should u prescribed ? A. High calorie B. Gluten free C. Partial hydrolysed formula D. Forget the option What is the increase mortality and morbidity? preterm delivery Vaginal delivery CS delivery twin pregnancy what will increase mortality ? A⁃ preterm B ⁃ Cs C ⁃ Vaginal D ⁃ Instrumental 48 of 51 Came with it , bleeding sometimes after trauma What is the management .? 49 of 51 Labia ulcer or abscess I don’t remember ()الصوره كانت حقيقيه و اوضح من هذي (Black female genitalia) 1-TTN 2-PE on ECG 3-OPEN fracture 4-STEMI 5-IDA 6-case of hydrated cyst + CT abdomen w/o contrast showed : cysts on liver , how treat it ? Albendazole 7-Transient tachypnea of the newborn 8-bowel perforation 9-ECG shows st elevation on II III avF , so Dx STEMI , in ER managed so what’s the nest step ? PCI 10-Gardnerella vaginalis (bacterial vaginosis) 11-SVT 13-common bile duct dilate – Mangemt ERCP 14-Boot sign > TOF 15-TTN 16-RDS 17-Failure to thrive 18-SVT ecg 19-Ecg for Mi what part ? 50 of 51 20- xray pulmonary edema and diagnosis 21- scfe picture and hx 22- CXR of neonate with distress ( preterm ) >>> respiratory distress syndrome 23- ECG of STMI with apex systolic regurgitation >>>Dx > mitral regurgitation 24- Condylomatalata (valvua ) 51 of 51
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